HEADACHE NEW PATIENT

OVERALL_INSTRUCTIONS

Chief Complaint

Neurology Consult Letter Template

Template

Dear Dr. [Referring Physician’s Name], [Patient Full Name] is a [Patient Age]-year-old [right/left]-handed [gender identity] who was reviewed in neurologic assessment for headaches. [Pronoun] was reviewed today via [in-person / telehealth]. As per the referral letter: [Briefly restate the reason for referral as provided by the referring physician, including any pertinent background or comorbidities.] PCC - Intake History Age of Headache Onset: [Extract from intake form] Headache Triggers: [Extract all triggers or “None identified” if blank] Location of Headaches: [Specify exact locations per intake form] Quality of Headache: [List descriptors from intake form (e.g., throbbing, sharp, pressure-like)] Severity of Headaches: [Numeric rating or qualitative descriptor] Headache days per week: [Days per week or per month] Aggravating Factors: [List from intake form or “None identified”] Alleviating Factors: [List from intake form or “None identified”] Neuro Symptoms Associated with Headaches: [List positive symptoms such as photophobia, phonophobia, nausea, etc.] [Explicitly list all pertinent negatives (no visual disturbances, no facial weakness, no speech changes, etc.)] Red Flag Neurologic Symptoms: [Summarize from intake form or note “None reported”] Associated Systemic Symptoms: [Include positives and negatives from intake form] Previous Medication Trials for Headaches: [List or note “None”] Medication Coverage: [e.g., MSP, private insurance, unknown] Past Medical History: [List all conditions from intake or chart, separated by commas] Medications: [List all medications, including over-the-counter or supplements] Allergies: [List or write “NKDA”] Social History: [Occupation, marital status, children, diet, exercise habits, smoking/alcohol/recreational drug use, driving status] Family History: [Include relevant hereditary or neurologic conditions (e.g., migraines, heart disease, kidney issues)] Focused Neurologic Examination: [Include templated neurologic findings if available, or “Deferred due to telehealth format.”] Investigations: [Summarize relevant investigations reviewed (labs, imaging, etc.) or state “No recent relevant investigations available.”] Thank you for involving me in the care of this patient. Collaborative assessment performed by John Quilon (PCC/MOA), Kate Edwardson (PCC/MOA/HCA), and Dr. N Randhawa.